USMLE17

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USMLE17
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2015-02-19 18:45:54
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  1. Describe the presentation and clinical findings of an Aspiration pneumonia.
    • Presents with: Fevers, night sweats, weight loss, productive cough, greenish foul-smelling sputum.
    • Patient: ALCOHOLIC/ EPILEPTIC (SEIZURE) - loss of consciousness
    • Clinical findings: Chest X ray reveals a CAVITARY lesion with air-fluid levels 
  2. Which individuals are susceptible to aspiration pneumonia?
    Occurs in individuals with impaired consciousness or decreased ability to swallow (alcoholics, demented, epileptic, chronically ill patients, bronchial obstruction-cancer)
  3. What are the most frequent pathogens of aspiration pneumonia?
    Anaerobes- Fusobacterium, Bacteriodes, Peptosteptococcus and S.aureus
  4. Where does the majority of water resorption in the nephron occur?
    In the proximal convoluted tubule.
  5. Golden yellow or brownish cytoplasmic granules are characteristic of?
    • Either lipofuscin or hemosiderin
    • The prussian blue stain can differentiate the two
  6. What does the Prussian blue stain detect?
    Intracellular iron e.g hemosiderin
  7. The presence of hemosiderin-laden macrophages in pulmonary alveoli indicates?
    Chronic elevation of pulmonary capillary hydrostatic pressures (Pulmonary edema) which is usually the result of LEFT HEART FAILURE.
  8. What causes the formation of heart failure cells?
    Left-sided heart failure→ ⇧pulmonary venous pressure → ⇧ leakage of iron-containing proteins and RBCs into the intersitum Macrophages phagocytize the iron-containing proteins and convert them to hemosiderin 
  9. Alkaline phosphatase is a tumor marker for which diseases?
    • Metastases to: Bone, Liver,
    • Paget disease of bone
    • Seminoma (placental ALP)
  10. Antimitochondrial autoantibodies are diagnostic of?
    Primary biliary cirrhosis
  11. What causes Primary biliary cirrhosis?
    • Autoimmune destruction in which LYMPHOCYTIC INFILTRATE and GRANULOMAS destroy the intralobular bile ducts.
    • This results in cholestasis (↓bile flow).
  12. This disease is characterized by autoimmune destruction of the intrahepatic bile ducts and cholestatis (decreased bile flow).
    Primary biliary cirrhosis
  13. Describe the histological findings of Alcoholic hepatitis.
    • Hepatocellular swelling and necrosis
    • Mallory bodies (intracytoplasmic eosinophilic inclusions of damaged keratin filaments)
    • Neutrophilic infiltration
  14. What are Mallroy bodies and in which disease are they characteristic of?
    • Intracytoplasmic eosinphilic inclusions of damaged keratin filaments
    • Alcoholic hepatitis
  15. Intracytoplasmic eosinophilic inclusions of damaged keratin filaments are characteristic of?
    • Mallory bodies 
    • Alcoholic hepatitis
  16. Hepatocellular swelling and necrosis, mallory bodies, neutrophilic infiltration and fibrosis are characteristic of?
    Alcoholic hepatitis
  17. Describe the liver changes in Reye syndrome.
    Fatty liver (microvesicular steatosis)
  18. In this disease liver biopsy demonstrates a microvesicular fatty change
    Reye syndrome
  19. Describe the liver changes in Budd-Chiari syndrome
    Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis.
  20. Centrilobular congestion and necrosis are characteristic of?
    Budd-chiari syndrome
  21. Degeneration of the posterior column and spinocerebellar tract is characteristic of?
    • Vitamin E deficiency
    • Friedreich ataxia
  22. What are the effects of Vitamin E deficiency on the nervous system?
    • Degeneration of the spinocerebellar tracts and dorsal/ posterior column.
    • Ataxia, dysarthria, loss of both position and vibration sensation.
  23. What is dysarthria?
    Impaired movement of the muscles used for speech production
  24. Poliomyelitis causes damage to which part of the spinal cord?
    Destruction of anterior horns.
  25. Desctruction of the anterior horns of the spinal cord is characteristic of?
    Poliomyelitis
  26. What are the low-molecular-weight heparins?
    • Enoxaparin
    • Dalteparin
  27. What is the MOA of Enoxaparin?
    • Low-molecular-weight heparin 
    • Activates antithrombin III which binds to factor 10a and stops factor 10a from converting prothrombin to thrombin.
  28. What is the function of t-PA?
    Converts plasminogen to plasmin which breaks down fibrin.
  29. What is factor II?
    Prothrombin
  30. What is an Accessory nipple?
    • A.k.a polythelia
    • Are usually asymptomatic but may swell or become tender along with the other breast tissue before or during menes, during pregnancy and lactation. 
  31. What are Ephelides/ Ephelis?
    • Freckles
    • ↑melanin pigment, normal number of melanocytes
  32. Describe the IP3/DAG secondary messenger system.
    • 1. Hormone binds to Gq receptor.
    • 2. Phospholipase C is activated.
    • 3. Phospholipase C degrades PIP2 (phosphatidylinositol 4, 5, bisphosphate) to IP3 (inositol 1,4,5-triphosphate) and DAG (diacylglycerol).
    • 4. IP3 increases intracellular calcium, and elevated intracellular calcium activates protein kinase C.  DAG also activates protein kinase C.
  33. Where are enhancers located?
    • Enhancers/ represors may be located anywhere upstram, downstream or even within the transcribed gene.
    • VARIABLE REGIONS
  34. Where is the TATA or Hogness box located?
    25 nucleotides upstream
  35. This promoter region is located 25 nucleotides upstream.
    TATA/ Hogness
  36. Where is the CAAT box located?
    70 to 80 nucleotides upstream
  37. This promoter region is located 70 to 80 bases upstream
    CAAT box
  38. What are the effects of timolol in the treatment of glaucoma?
    • Beta blocker
    • ↓aqueous humor production by the ciliary epithelium 
  39. What are the effects of Latanoprost in the treatment of glaucoma?
    • Prostaglandin (PGF2α)
    • ↑outflow of aqueous humor
  40. Which prostaglandins are used in the treatment of glaucoma? How do they work?
    • Prostaglandin (PGF2a)- Latanoprost, Unoprostone, Travoprost
    • ↑outflow of aqueous humor
  41. What conditions can be caused by Clostridium perfringens?
    Late onset food poisoning → transient watery diarrhea

    Gas gangrene
  42. What is humor defense mechanism?
    • Conscious/ unconscious  making light of an uncomfortable situation.
    • E.g. joking about the boards prior to the exam.
  43. What is isolation? Give an example.
    • Removing disturbing feelings from an event.
    • E.g. Describing a murder in graphic detail with no emotional response.
  44. What is Altruism? Give an example.
    • Ameliorating feeling of guilt by giving to others without solicitation.
    • E.g Mafia boss makes large donation to charity
  45. What is responsible for the value of the resting membrane potential?
    High K+ efflux and low Na+ influx
  46. What is the mechanism of Amphotericin B?
    Binds ergosterol, forms membrane pores that allow leakage of electrolytes.
  47. This drug binds ergosterol, forms membrane pores that allow leakage of electrolytes.
    Amphotericin B
  48. This anti-HIV drug suppresses bone marrow function.
    Zidovudine
  49. This druf interferes with microtubule function; disrupts miosis.
    Griseofulvin
  50. What is the MOA of Griseofulvin?
    Interferes with microtubule function; disrupts mitosis
  51. What is the MOA of the Azoles (fluconazole ect)?
    Inhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P450 enzyme that converts lanosterol to ergosterol
  52. What are the side effects of Amphotericin B?
    • Fever/ chills ("shake and bake"), hypotension
    • Nephrotoxicity (↓GFR, ↑BUN/Cr)
    • Arrythmias
    • Anemia
    • Thrombophlebitis at site of injection
  53. Where is secretin produced?
    S cells of the duodenum.
  54. This hormone is produced by the S cells of the duodenum.
    Secretin
  55. What are the effects of secretin on the pancreas?
    Secretin is a hormone produced by the S endocrine cells in the duodenum that increases bicarbonate secretion from the pancreas.
  56. What is the most potent stimulus for S cell secretin release?
    Gastric hydrochloric acid into the duodenum is the most potent stimulus for S cell secretin release.
  57. Describe the polymerization of hemoglobin molecules seen in sickle cell disease.
    • In HbS, a charged glutamic acid residue is replaced by a nonpolar HYDROPHOBIC Valine resiude at the 6th amino acid position in the beta subunit.
    • This promotes hydrophobic interactions among hemoglobin molecules and results in polymerization of HbS molecules
  58. Glutamic acid to lysine mutation in the beta globin chain is characteristic of?
    HbC defect
  59. What is HbC defect
    Glutamic acid to lysine mutation in the beta globin chain
  60. What is the most common mutation in HbM disease/ methemoglobin?
    • Replacement of histidine in the heme pocket with tyrosine. 
    • This alteration results in the formation of a complex that resists the reduction of iron to the ferrous (Fe2+ state).
  61. In this condition, there is a replacement of histidine in the heme pocket with tyrosine.
    Methemoglobin/ Hemoglobin M disease
  62. What is the general cause of elevated levels of creatine kinase?
    • Cellular membrane destruction
    • Heart, brain, skeletal muscle
  63. What is Mitochondrial permeability/ vacuolization and which type of cell injury is it associated with?
    • Phospholipid-containing amorphous densities within the mitochondria.
    • Irriversible cell injury- reduces cellular capacity for ATP generation.
  64. What are phospholipid-containing amorphous densities within the mitochondria?
    • Mitochondrial permeability/ vacuolization
    • Irriversible cell injury
  65. What is nuclear pyknosis and what type of cell injury is it associated with?
    • Shrinkage, condensation of chromatin
    • Irriversible cell injury.
  66. Which cranial nerve/ vessels pass through the jugular foramen?
    CN 9, 10, 11 and Jugular vein
  67. This nerve causes secretion (salivation) from the parotid gland.
    Glossopharyngeal - CN 9
  68. A lesion to this cranial nerve results in loss of taste from the posterior 1/3 of the tongue.
    Glossopharyngeal -CN 9
  69. Loss of gag reflex results in a lesion to which cranial nerve?
    • CN 9- Glossopharyngeal
    • CN 10- Vagus
  70. Dysphagia results in a lesion to which cranial nerve?
    • CN 9 - Glossopharyngeal
    • CN 10- Vagus
  71. Dysphonia/hoarseness results in a lesion to which cranial nerve?
    Vagus- CN 10
  72. Soft palate drop with deviation of the uvula toward the normal side results from a lesion to which cranial nerve?
    Vagus - CN10
  73. Sternecleiodomastoid and trapezius muscle paresis is due to a lesion to which cranial nerve?
    Accessory - CN 11
  74. Which cranial nerve passes through the cribiform plate?
    CN 1 - Olfactory bundles
  75. Where does CN1- Olfactory pass through?
    Cribiform plate
  76. Which cranial nerve passes through the foramen ovale?
    Trigeminal nerve- mandibular division CN53
  77. Where does the mandibular division of the trigeminal nerve (CNV3) pass through?
    Foramen ovale
  78. Which cranial nerve passes through the foramen rotundum?
    Tigeminal - maxillary division (CNV2)
  79. Where does the maxillary division of the trigeminal nerve (CNV2) pass through?
    Foramen rotundum
  80. Which cranial nerve passes through the hypoglossal canal?
    CN 12- Hypoglossal nerve
  81. Which cranial nerve passes through the internal acoustic meatus?
    • CN 7- Facial
    • CN 8- Vestibulocochlear
  82. Where does the facial nerve (CN7) pass through?
    Internal acoustic meatus
  83. Where does the vestibulocochlear nerve (CN8) pass through?
    Internal acoustic meatus
  84. Where does the glossopharyngeal nerve (CN9) pass through?
    Jugular foramen
  85. Where does the jugular vein pass through?
    Jugular foramen
  86. Where does the vagus nerve (CN10) pass through?
    Jugular foramen
  87. Where does the accessory nerve (CN11) pass through?
    Jugular foramen
  88. Why is methadone the drug of choice for treating heroin addiction and abuse?
    • It is very potent, LONG-ACTING, with good oral bioavailability.
    • Its long half-life allows for prolonged effects to suppress withdrawal symptoms in heroin dependent patients.
  89. What is Caudal regession syndrome and what condition is it most commonly associated with?
    • Patients are born with agenesis of the sacrum and lumbar spine.
    • Results in flaccid paralysis of the legs
    • Absent ankle reflexes
    • Dorsiflexed contractures of the feet
    • Urinary incontinence
    • Associated with maternal diabetes
  90. Vitamin A overdose in pregnancy can cause?
    • Craniofacial abnormalities- e.g. cleft palate, posterior fossa CNS defects
    • Cardiac- great vessels abnormality
    • Similar to Di Georges syndrome
  91. Strict vegetarians/ vegans are at risk for?
    B12 and iron deficiencies 
  92. What are the effects of iron deficiency anemia in pregnancy?
    Restrict fetal growth

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